Individualized CareDoctors at the Siteman Cancer Center are experts in the diagnosis and treatment of leukemia, a cancer of the blood-forming cells. When leukemia develops, the body produces large numbers of abnormal blood cells that look and behave differently from normal cells. This disease may cause a rapid death. But many patients can live for months or years and be cured using modern therapies.

Our doctors examine new patients thoroughly then discuss results and medical records at a meeting of leukemia specialists. Together, they develop individualized treatment plans. The first visit to Siteman will take several hours. If patients already have had X-rays or medical tests, they will be asked to bring along the results.

Types of LeukemiaDifferent types of leukemia are named after the blood cells that are affected and how fast they grow. Acute leukemias – the most dangerous – have cells that grow very quickly and will cause death without immediate treatment. Chronic leukemias evolve more slowly and require many different therapies, including bone marrow and stem cell transplantation. Some chronic leukemias, such as chronic myeloid leukemia, lead to a form of acute leukemia. Our leukemia physicians also are experts in the treatment of bone marrow failure states such as myelodysplasia and aplastic anemia.

Leukemia is diagnosed by examining blood and bone marrow cells with a microscope. Bone marrow is taken from the hip bone with a long needle after a painkiller is injected. Washington University doctors at Siteman have helped develop state-of-the-art tests for identifying and treating leukemia.

All patients who come to Siteman for treatment of leukemia and bone marrow failure states will be offered the chance to participate in clinical trials testing cutting-edge therapies for these diseases.

Chemotherapy TreatmentThe most effective treatment for leukemia is chemotherapy, the use of a drug or combination of drugs that travel through the blood and kill cancer cells. The short-term goal of chemotherapy is complete remission, meaning no trace of leukemia in the blood or bone marrow. The long-term goal is to maintain this remission.

A bone marrow test usually is done before treatment starts and again a few weeks later to measure response to chemotherapy drugs. Each person’s leukemia responds differently. Using genetic information from a patient’s blood cells, our researchers are studying ways to predict which drugs will work best.

Because treatment lasts so long, doctors insert a tube into a vein leading to the heart, either just below the collarbone or in the front of the elbow. It can remain there safely for several weeks or months and is a good way to give antibiotics, chemotherapy drugs or blood transfusions without sticking patients with a new needle each time. Patients and family members learn how to keep the tube, called a catheter, clean.

Patients with a type of leukemia called acute myeloid leukemia (AML) come to the hospital for several days in a row for chemotherapy. Each visit takes several hours. Patients who don’t live nearby often stay close to the hospital. (Nurse coordinators can help make those arrangements.) When a patient’s blood tests show remission, three or four additional three-day treatments are given. This additional chemotherapy – with high drug doses – is needed to make sure remission lasts.

Patients with a type of leukemia called acute lymphocytic leukemia (ALL) usually check into the hospital for their first round of chemotherapy treatments, a mix of four or five different drugs. After that, they have six more months of very strong chemotherapy treatment. Finally, they move on to 18 months of treatment with drugs given through a catheter or taken by mouth to ensure the disease doesn’t come back.

Our doctors and researchers test new drugs and treatments for leukemia in clinical trials. Some are looking for ways to make chemotherapy less poisonous to healthy cells or kill only abnormal cells. They hope to find new combinations of drugs that lead to longer remissions. They also are trying to find out why some cancerous cells are not killed by drugs. About 20 percent of Siteman patients take part in clinical trials, giving them access to treatments that aren’t widely available.

Bone Marrow and Stem Cell TransplantsBone marrow or stem cell transplantation may be necessary for some patients. Transplants replace blood-producing cells that have been destroyed by diseases such as leukemia. The procedure is called bone marrow transplantation if the transplanted cells are taken from the bone and stem cell transplantation if the cells are collected from the blood.

Siteman’s bone marrow and stem cell transplant program is one of the largest in the world, performing about 275 transplants each year. For more information on bone marrow transplants, CLICK HERE.

Support ServicesOur treatment team includes psychiatrists, psychologists, social workers and chaplains who help with transportation, housing, financial matters and grief. Support groups meet regularly. Our immediate goal is to make sure patients receive the most advanced treatment available. Our larger aim is to treat patients and their families with compassion all the way through treatment.